Temporal trends in ankyloglossia and frenotomy in British Columbia, Canada, 2004-2013: a population-based study

K.S. Joseph; Brooke Kinniburgh; Amy Metcalfe; Neda Razaz; Yasser Sabr; Sarka Lisonkova

doi:10.9778/cmajo.20150063

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Figure 1
Rates of ankyloglossia and frenotomy by year (A) and by proportion of infants who were breast milk fed (B), and temporal trends in frenotomy among ankyloglossia cases (C).

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Table 1: Frequency of ankyloglossia by maternal and infant characteristics among all live births, British Columbia, Canada, 2004-2013

Characteristic	No. of live births	Ankyloglossia
Characteristic	No. of live births	No. of cases	Rate per 1000 live births (95% CI)	Rate ratio (95% CI)
Maternal age, yr
< 20	14 073	98	7.0 (5.7-8.5)	1.01 (0.81-1.25)
20-24 (ref)	61 794	428	6.9 (6.3-7.6)	1.00 (-)
25-29	126 550	811	6.4 (6.0-6.9)	0.93 (0.82-1.04)
30-34	151 380	1 016	6.7 (6.3-7.1)	0.97 (0.87-1.08)
35-39	85 717	557	6.5 (6.0-7.1)	0.94 (0.83-1.06)
≥ 40	19 927	112	5.6 (4.6-6.8)	0.81 (0.66-1.00)
Parity
Nulliparous	214 690	1 656	7.7 (7.3-8.1)	1.38 (1.29-1.48)
Multiparous (ref)	244 728	1 366	5.6 (5.3-5.9)	1.00 (-)
Body mass index
< 18	19 449	120	6.2 (5.1-7.4)	0.94 (0.78-1.13)
18-24 (ref)	194 100	1 276	6.6 (6.2-6.9)	1.00 (-)
25-29	66 173	439	6.6 (6.0-7.3)	1.01 (0.91-1.12)
≥ 30	40 720	302	7.4 (6.6-8.3)	1.13 (1.00-1.28)
Missing data	139 003	885	6.4 (6.0-6.8)	0.97 (0.89-1.05)
Plurality
Singleton (ref)	443 374	2 956	6.7 (6.4-6.9)	1.00 (-)
Multiple	16 071	66	4.1 (3.2-5.2)	0.62 (0.49-0.79)
*Gestational age, wk**
28-36	39 573	209	5.3 (4.6-6.0)	0.75 (0.65-0.86)
37-43 (ref)	390 194	2 754	7.1 (6.8-7.3)	1.00 (-)
Missing data	27 832	55	1.9 (1.5-2.6)	0.28 (0.21-0.37)
Infant sex
Male	237 230	1 957	8.2 (7.9-8.6)	1.72 (1.60-1.85)
Female (ref)	222 208	1 065	4.8 (4.5-5.1)	1.00 (-)
Birth weight, g
< 1500	4 711	10	2.1 (1.0-3.9)	0.33 (0.18-0.62)
1500-1999	7 003	17	2.4 (1.4-3.9)	0.38 (0.24-0.61)
2000-2499	18 469	66	3.6 (2.8-4.5)	0.57 (0.45-0.72)
2500-2999	69 407	406	5.8 (5.3-6.4)	0.92 (0.85-1.00)
3000-3499 (ref)	163 673	1 075	6.6 (6.2-7.0)	1.00 (-)
3500-3999	137 549	967	7.0 (6.6-7.5)	1.04 (0.99-1.09)
4000-4499	46 636	393	8.4 (7.6-9.3)	1.23 (1.13-1.34)
≥ 4500	8 845	83	9.4 (7.5-11.6)	1.48 (1.19-1.84)
Missing data	3 152	5	1.6 (0.5-3.7)	0.25 (0.10-0.60)
Year
2004 (ref)	42 802	212	5.0 (4.3-5.7)	1.00 (-)
2005	43 147	233	5.4 (4.7-6.1)	1.09 (0.90-1.31)
2006	44 208	215	4.9 (4.2-5.6)	0.98 (0.81-1.19)
2007	46 617	258	5.5 (4.9-6.3)	1.12 (0.93-1.34)
2008	47 491	304	6.4 (5.7-7.2)	1.29 (1.09-1.54)
2009	47 762	306	6.4 (5.7-7.2)	1.29 (1.09-1.54)
2010	46 592	327	7.0 (6.3-7.8)	1.41 (1.19-1.68)
2011	47 025	396	8.4 (7.6-9.3)	1.70 (1.44-2.01)
2012	47 320	379	8.0 (7.2-8.8)	1.62 (1.37-1.91)
2013	46 481	392	8.4 (7.6-9.3)	1.70 (1.44-2.01)
Overall	459 445	3 022	6.6 (6.3-6.8)	-

Note: CI = confidence interval, ref = reference category.

*Results for live births < 28 weeks' gestation not shown because of small number of cases (< 5).

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Table 2: Frequency of ankyloglossia by length of infant's hospital stay among all live births, British Columbia, Canada, 2004-2013

Length of stay, h	No. of live births	Ankyloglossia
Length of stay, h	No. of live births	No. of cases	Rate per 1000 live births (95% CI)	Rate ratio (95% CI)
< 24	47 703	174	3.6 (3.1-4.2)	0.62 (0.53-0.72)
24-47 (ref)	182 578	1 079	5.9 (5.6-6.3)	1.00 (-)
48-71	104 509	850	8.1 (7.6-8.7)	1.38 (1.26-1.51)
72-95	59 906	546	9.1 (8.4-9.9)	1.54 (1.39-1.71)
96-167	28 940	268	9.3 (8.2-10.4)	1.57 (1.37-1.79)
≥ 168	13 404	63	4.7 (3.6-6.0)	0.80 (0.62-1.02)
Missing	22 405	42	1.9 (1.4-2.5)	0.32 (0.23-0.43)
Total	459 445	3 022	6.6 (6.3-6.8)	-

Note: CI = confidence interval, ref = reference category.

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Table 3: Logistic regression analysis showing association between maternal and infant determinants and ankyloglossia among term and post-term (37-43 wk) live births, British Columbia, Canada, 2004-2013

Determinant	No. of term and post-term live births	No. of cases	Rate per 1000 live births	Rate ratio (95% CI)
Determinant	No. of term and post-term live births	No. of cases	Rate per 1000 live births	Crude	Adjusted*
Age, yr
< 20	11 504	92	8.0 (6.5-9.8)	1.07 (0.85-1.34)	0.98 (0.78-1.23)
20-24 (ref)	52 289	391	7.5 (6.8-8.3)	1.00 (-)	1.00 (-)
25-29	108 508	742	6.8 (6.4-7.3)	0.91 (0.81-1.03)	0.93 (0.83-1.06)
30-34	129 939	930	7.2 (6.7-7.6)	0.96 (0.85-1.08)	1.01 (0.90-1.14)
35-39	71 894	495	6.9 (6.3-7.5)	0.92 (0.81-1.05)	1.01 (0.88-1.16)
≥ 40	15 968	104	6.5 (5.3-7.9)	0.87 (0.70-1.08)	0.96 (0.78-1.20)
Parity
0	180 970	1 519	8.4 (8.0-8.8)	1.42 (1.32-1.54)	1.47 (1.36-1.59)
≥ 1 (ref)	209 121	1 235	5.9 (5.6-6.2)	1.00 (-)	1.00 (-)
Body mass index
< 18	16 473	106	6.4 (5.3-7.8)	0.92 (0.75-1.12)	0.94 (0.77-1.14)
18-24 (ref)	167 813	1 174	7.0 (6.6-7.4)	1.00 (-)	1.00 (-)
25-29	56 208	398	7.1 (6.4-7.8)	1.01 (0.90-1.13)	1.01 (0.90-1.14)
≥ 30	33 730	270	8.0 (7.1-9.0)	1.15 (1.00-1.31)	1.14 (1.00-1.30)
Missing data	115 881	806	7.0 (6.5-7.5)	0.99 (0.91-1.09)	1.06 (0.97-1.16)
Plurality
Singleton (ref)	385 104	2 727	7.1 (6.8-7.4)	1.00 (-)	1.00 (-)
Multiple	4 995	27	5.4 (3.6-7.9)	0.76 (0.52-1.11)	0.68 (0.63-0.74)
Infant sex
Female (ref)	190 993	966	5.1 (4.7-5.4)	1.00 (-)	1.00 (-)
Male	199 106	1 788	9.0 (8.6-9.4)	1.78 (1.65-1.93)	1.74 (1.61-1.89)
Birth weight,† g
2000-2499	5 315	31	5.8 (4.0-8.3)	0.88 (0.61-1.25)	0.90 (0.63-1.29)
2500-2999	50 987	311	6.1 (5.4-6.8)	0.92 (0.81-1.04)	0.94 (0.82-1.06)
3000-3499 (ref)	149 808	996	6.6 (6.2-7.1)	1.00 (-)	1.00 (-)
3500-3999	131 133	945	7.2 (6.8-7.7)	1.08 (0.99-1.19)	1.06 (0.97-1.16)
4000-4499	44 505	389	8.7 (7.9-9.6)	1.32 (1.17-1.48)	1.26 (1.12-1.42)
≥ 4500	8 127	80	9.8 (7.8-12.2)	1.49 (1.18-1.87)	1.39 (1.11-1.76)
Year
2004 (ref)	36 593	199	5.4 (4.7-6.2)	1.00 (-)	1.00 (-)
2005	36 791	218	5.9 (5.2-6.8)	1.09 (0.90-1.32)	1.09 (0.90-1.32)
2006	37 802	202	5.3 (4.6-6.1)	0.98 (0.81-1.20)	0.98 (0.80-1.19)
2007	39 743	232	5.8 (5.1-6.6)	1.07 (0.89-1.30)	1.07 (0.88-1.29)
2008	40 267	281	7.0 (6.2-7.8)	1.29 (1.07-1.54)	1.28 (1.06-1.53)
2009	40 367	282	7.0 (6.2-7.8)	1.29 (1.07-1.54)	1.28 (1.07-1.54)
2010	39 610	279	7.0 (6.2-7.9)	1.30 (1.08-1.56)	1.29 (1.08-1.55)
2011	39 827	366	9.2 (8.3-10.2)	1.70 (1.43-2.02)	1.70 (1.43-2.02)
2012	39 936	335	8.4 (7.5-9.3)	1.55 (1.30-1.84)	1.55 (1.30-1.85)
2013	39 169	360	9.2 (8.3-10.2)	1.70 (1.43-2.02)	1.70 (1.43-2.02)

Note: CI - confidence interval, ref = reference category.

*Adjusted for all other factors in the table.

†Results for live births < 2000 g not shown because of small number of cases (< 5).

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Table 4: Logistic regression analysis showing association between maternal and infant determinants and frenotomy among term and post-term (37-43 wk) live births, British Columbia, Canada, 2004-2013

Determinant	No. of term and post-term live births	No. undergoing frenotomy	Rate per 1000 live births	Rate ratio (95% CI)
Determinant	No. of term and post-term live births	No. undergoing frenotomy	Rate per 1000 live births	Crude	Adjusted*
Age, yr
< 20	11 504	61	5.3 (4.1-6.8)	1.23 (0.92-1.65)	1.12 (0.84-1.49)
20-24 (ref)	52 289	225	4.3 (3.8-4.9)	1.00 (-)	1.00 (-)
25-29	108 508	447	4.1 (3.7-4.5)	0.96 (0.82-1.12)	0.98 (0.83-1.15)
30-34	129 939	546	4.2 (3.9-4.6)	0.98 (0.84-1.14)	1.04 (0.89-1.21)
35-39	71 894	281	3.9 (3.5-4.4)	0.91 (0.76-1.08)	1.01 (0.84-1.21)
≥ 40	15 968	50	3.1 (2.3-4.1)	0.73 (0.54-0.99)	0.82 (0.60-1.12)
Parity
0	180 970	912	5.0 (4.7-5.4)	1.51 (1.37-1.67)	1.56 (1.40-1.72)
≥ 1 (ref)	209 121	698	3.3 (3.1-3.6)	1.00 (-)	1.00 (-)
Body mass index
< 18	16 473	65	3.9 (3.0-5.0)	0.96 (0.74-1.24)	0.98 (0.76-1.27)
18-24 (ref)	167 813	691	4.1 (3.8-4.4)	1.00 (-)	1.00 (-)
25-29	56 208	231	4.1 (3.6-4.7)	1.00 (0.86-1.16)	0.99 (0.86-1.56)
≥ 30	33 730	166	4.9 (4.2-5.7)	1.20 (1.01-1.42)	1.18 (0.99-1.40)
Missing data	115 881	457	3.9 (3.6-4.3)	0.96 (0.85-1.08)	1.03 (0.91-1.16)
Plurality
Singleton (ref)	385 104	1 596	4.1 (3.9-4.3)	1.00 (-)	1.00 (-)
Multiple	4 995	14	2.8 (1.5-4.7)	0.68 (0.40-1.14)	0.79 (0.46-1.36)
Infant sex
Female (ref)	190 993	534	2.8 (2.6-3.0)	1.00 (-)	1.00 (-)
Male	199 106	1 076	5.4 (5.1-5.7)	1.93 (1.74-2.14)	1.87 (1.69-2.08)
Birth weight,† g
2000-2499	5 315	17	3.2 (1.9-5.1)	0.84 (0.52-1.36)	0.87 (0.53-1.41)
2500-2999	50 987	163	3.2 (2.7-3.7)	0.84 (0.71-1.00)	0.86 (0.72-1.02)
3000-3499 (ref)	149 808	569	3.8 (3.5-4.1)	1.00 (-)	1.00 (-)
3500-3999	131 133	566	4.3 (4.0-4.7)	1.14 (1.01-1.28)	1.11 (0.99-1.25)
4000-4499	44 505	245	5.5 (4.8-6.2)	1.45 (1.25-1.68)	1.39 (1.19-1.62)
≥ 4500	8 127	49	6.0 (4.5-8.0)	1.59 (1.19-2.12)	1.49 (1.11-2.00)
Year
2004 (ref)	36 593	116	3.2 (2.6-3.8)	1.00 (-)	1.00 (-)
2005	36 791	126	3.4 (2.9-4.1)	1.08 (0.84-1.39)	1.08 (0.84-1.39)
2006	37 802	112	3.0 (2.4-3.6)	0.93 (0.72-1.21)	0.93 (0.72-1.21)
2007	39 743	131	3.3 (2.8-3.9)	1.04 (0.81-1.33)	1.03 (0.80-1.33)
2008	40 267	164	4.1 (3.5-4.7)	1.28 (1.01-1.63)	1.28 (1.01-1.62)
2009	40 367	154	3.8 (3.2-4.5)	1.20 (0.95-1.53)	1.20 (0.94-1.53)
2010	39 610	165	4.2 (3.6-4.9)	1.31 (1.04-1.67)	1.31 (1.03-1.66)
2011	39 827	208	5.2 (4.5-6.0)	1.65 (1.31-2.07)	1.66 (1.32-2.08)
2012	39 936	204	5.1 (4.4-5.9)	1.61 (1.28-2.02)	1.62 (1.29-2.04)
2013	39 169	230	5.9 (5.1-6.7)	1.85 (1.48-2.31)	1.87 (1.49-2.33)